Vein Treatment Procedure FAQ's

Microphlebectomy

Are there any side effects?

A common side effect is a varying degree of bruising which tends to disappear within several weeks. Other possible but less common side effects include mild swelling, discomfort, skin discoloration and scarring.

How long do I have to wear the dressings/bandages?

The dressings are removed the following day in order to shower and then reapplied. The compression bandage (ace wrap) should be worn for a total of 3 days. On days 4-7, compression stockings should be worn during the day. You must only wear the compression bandage overnight on the 1st night. The compression bandages/stockings may then be removed in order to shower and at night prior to going to bed.

Am I going to be asleep during the procedure?

No, the procedure is done under a local anaesthetic.

Is the operation going to be painful?

The great advantage of ambulatory phlebectomy is that it is completely painless. Everything is done under a local anaesthetic and the utmost care is taken to make the patient as comfortable and relaxed as possible. The post operative period is also relatively pain free, however, a mild analgesia in the form of Tylenol or ibuprofen can be taken for any discomfort postoperatively.

How many days do I need to take off work?

One of the greatest advantages of ambulatory phlebectomy is that it does not require any time off work except on the day of the operation. Normal activities can be resumed the next day.

Once the veins have been removed will they come back?

No, they do not come back as they are physically removed.

How are the veins removed?

The method which I use is called microphlebectomy. In general the removal of the veins is achieved in a very non-invasive and non traumatic way. Most of the veins can be removed through a tiny hole made by the puncture of a needle. The procedure is not painful because local anaesthetic is used before hand.

Is the operation safe?

The operation is very safe. Patients are thoroughly examined beforehand and carefully selected.

Sclerotherapy

Is it covered by private insurance or Medicare?

No, sclerotherapy is considered a cosmetic treatment and is not covered by insurance or medicare.

How much does it cost?

The cost for sclerotherapy is $300 per treatment session. The first treatment involves an extra $100 cost to cover the special dressings and compression stockings that need to be worn following sessions.

What could the complications be?

Complications occur in less than 1% of patients. The most common complication is to have a small dark mark or bruise at the injection site for a while. For most patients these marks fade very quickly, usually within two to three weeks. Some patients develop very tiny veins as a result of sclerotherapy. For most patients these fade quickly and for others very gentle conservative treatment with laser is necessary. Rarely, hyperpigmentation can occur following sclerotherapy. This may be the result of some leakage of blood through the vessel wall at the time of sclerotherapy. Most hyperpigmentation will subside over time. Allergies to sotradecol are rare, but can occur.

Does it hurt?

Most patients find the treatment slightly uncomfortable but much less so than they had imagined.

How much time do I have to leave between sessions?

We usually leave 1 month in between sessions to allow time for healing.

Why do I have to wear compression stockings?

Compression stockings are used to keep pressure on the area to produce a better result and to increase comfort for the patient. You need to wear these the day of treatment and overnight that night (without removing them). You will then wear them during the day for the next 4 days (total of 5 days). You can remove them at night before going to bed and prior to showering.

How long will I need off work?

You will not need to take time off work other than for your appointment. However, you should not plan to have any strenuous exercise or fly internationally for at least the first 48 hours.

What will my legs look like afterwards?

You will be wearing special dressings and compression stockings. It is a good idea to wear pants or a long skirt for your appointment. It is best if the pants are not too tight or stretchy as the pressure bandages will make your legs look lumpy. The veins do tend to go slightly darker in color before they disappear due to the color of the blood inside the vein as it closes.

How much is involved in one session?

Each session typically lasts 30 minutes. Both legs can be treated in one session. Of course, some patients have so many veins that we cannot get to each and every vein in one session.

What other methods are available?

Veinwave – veinwave can be used in along with with sclerotherapy for veins that are smaller in diameter. Lasers – lasers are not yet at a stage where they are helpful in the treatment of larger leg veins. Lasers are best used for treating abnormal blood vessels on the face, new matting or very fine red surface veins.

How many treatments will it take?

People differ in the extent of their problem and therefore in the amount of treatment needed. The number of treatments is typically between 3-6 treatments.

Will the veins come back?

Treated veins can sometimes recur. Touch-up treatments will minimize this. The more treatments you have, the better the results will be.

Is it effective?

After several treatments (3-6) most patients can expect a 70-90% improvement in the appearance of their legs. Your legs will initially look worse because of bruising and blood entrapment. The improvement may be very gradual, with some vessels taking up to 2 months to show maximum benefit. Treatments are usually performed monthly, sometimes more regularly.

How does it work?

Sclerotherapy works by irritating the lining of the vein and stopping blood flow in it. Over a period of weeks to months the vessel fades from view, eventually becoming barely or not at all visible. Depending on its size, a single blood vessel may have to be injected more than once.

Veinwave™

Veinwave™ uses a new method called thermo-coagulation. It can be used on any type of skin, without causing bruising and there is no need for bandages. One treatment session lasts about 15 minutes and can treat up to 30 cm of veins on any part of the body. There are no major side effects, no allergic reactions and no bruising. It can be used on sensitive areas of the body. Some trials have shown that 80% of patients prefer Veinwave™ to injections.

Can I see how it has worked for others?

Dr Mountcastle keeps a photographic record of Veinwave™ treatment and he would be happy to show you the results of treatment.

Does Veinwave™ work for all spider veins?

Veinwave™ is effective on small blue veins on the legs and the fine red veins on the face. It does not always work on very fine red veins on the legs that are matted.

Are there any problems with Veinwave™?

In one study of over 800 treatment sessions there have been no reports of complications from Veinwave™. If you are allergic to Nickel then please tell the person giving you the Veinwave™ treatment.

The main problem appears to be failure of the treatment to remove all spider veins. It is for these reasons that repeat treatments may be necessary. The results are obvious in most patients after 6 weeks but for some people, it can take longer for the treatment to work.

Will the Veinwave™ treatment be permanent?

Spider veins can recur or new areas can be affected so it may be necessary to have several sessions over months or years.

How many treatments will I need?

This depends on how many spider veins you have and how easy it is to treat your leg. Each session involves nearly 250 pulses so about 30-50cm of spider veins can be treated. Most people can be treated in 3 to 5 sessions.

Patients who complain of varicose veins, heavy, painful legs, swelling, or a tired or restless feeling in the legs may be a candidate for the procedure. However, a detailed medical history, exam and venous ultrasound must be performed in order to determine who is a good candidate.

What is it that you inject?

The most commonly used injections are sotradecol. Polidocanol (Asclera) is the newest sclerosing agent that was just recently FDA approved and will be coming soon! Polidocanol, has anesthetic properties, which can make Asclera a less painful treatment option for patients.

What are patients saying about the Closure procedure?

98% of patients who have undergone the Closure procedure are willing to recommend it to a friend or family member with similar leg vein problems.

Is the Closure treatment covered by my insurance?

Many insurance companies are paying for the Closure procedure in part or in full. Most insurance companies determine coverage for all treatments, including the Closure procedure, based on medical necessity. The VNUS Closure procedure has positive coverage policies with most health insurers. Your physicians can discuss your insurance coverage further at the time of consultation.

What happens to the treated vein left behind in the leg?

The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue. One study reported that 89% of treated veins are indistinguishable from other body tissue one year after the Closure procedure was performed.

How effective is the Closure procedure?

Published data suggests that two years after treatment, 90% of the treated veins remain closed and free from reflux, the underlying cause of varicose veins.

Is age an important consideration for the Closure procedure?

The most important step in determining whether or not the Closure procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age alone is not a factor in determining whether or not the Closure procedure is appropriate for you. The Closure procedure has been used to treat patients across a wide range of ages.

Is the Closure procedure suitable for everyone?

Only a physician can tell you if the Closure procedure is a viable option for your vein problem. Experience has shown that many patients with superficial venous reflux disease can be treated with the Closure procedure.

Are there any potential risks and complications associated with the Closure procedure?

As with any medical intervention, potential risks and complications exist with the Closure procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the Closure procedure at the consultation, and can be reviewed in the safety summary. Potential complications can include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling) and/or skin burn.

Is there any scarring, bruising, or swelling after the Closure procedure?

Patients report minimal to no scarring, bruising, or swelling following the Closure procedure.

How soon after treatment will my symptoms improve?

Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

How quickly after treatment can I return to normal activities?

Many patients can resume normal activities immediately. For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing.

Will the procedure require any anesthesia?

The Closure procedure can be performed under local, regional, or general anesthesia.

Is the Closure procedure painful?

Patients report feeling little, if any, pain during the Closure procedure. Your physician will give you a local or regional anesthetic to numb the treatment area.

How long does the Closure procedure take?

The Closure procedure typically takes about 3-5 minutes, though patients normally spend 30 minutes at the medical facility due to normal pre and post treatment procedures.

How does it work to treat superficial venous reflux?

Since valves can’t be repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from your leg. The Closure procedure provides a less invasive alternative to vein stripping by simply closing the problem vein instead. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs.

How is the Closure procedure different from vein stripping?

During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your calf.

In the Closure procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, under a general anesthetic, while the Closure procedure is performed on an outpatient basis, typically using local or regional anesthesia.

Three randomized trials of the Closure procedure vs. vein stripping, including the most recent multi-center comparative trial, show very similar results. In the multi-center comparative trial, the Closure procedure was superior to vein stripping in every statistically significant outcome. In the study, 80.5% of patients treated with the Closure procedure returned to normal activities within one day, versus 46.9% of patients who underwent vein stripping. Also, Closure patients returned to work 7.7 days sooner than surgical patients. Patients treated with the Closure procedure had less postoperative pain, less bruising, faster recovery and fewer overall adverse events.